Urethral Prolapse – Causes, Symptoms and Treatment
Urethral prolapse is a condition in which the inner lining of the urethra protrudes through the urethral opening. It mainly affects prepubescent girls and postmenopausal women.
Things worth knowing about "Urethral Prolapse"
Urethral prolapse is a condition in which the inner lining of the urethra protrudes through the urethral opening. It mainly affects prepubescent girls and postmenopausal women.
What is Urethral Prolapse?
Urethral prolapse is a benign condition in which the mucosal lining of the urethra (the tube through which urine exits the body) protrudes outward through the urethral opening. This creates a soft, ring-shaped tissue protrusion around the external urethral meatus. Although it is not dangerous, it can cause discomfort and bleeding, and should be evaluated and treated by a healthcare professional.
Causes
The exact cause of urethral prolapse is not always clearly defined. Several contributing factors have been identified:
- Estrogen deficiency: Low estrogen levels in prepubescent girls or postmenopausal women weaken the connective tissue supporting the urethra, making prolapse more likely.
- Weak connective tissue: Congenital or age-related laxity of the periurethral support structures.
- Increased intra-abdominal pressure: Chronic cough, constipation, or straining during bowel movements can trigger or worsen the prolapse.
- Local trauma: In rare cases, physical injury to the urethral area may contribute.
Symptoms
Symptoms can vary depending on the severity of the prolapse:
- A visible, soft, red or bluish-red tissue mass around the urethral opening
- Urethral bleeding, often painless (commonly the first sign noticed in children)
- Burning or pain during urination (dysuria)
- Frequent urge to urinate
- Sensation of a foreign body in the genital area
- Rarely: urinary retention in severe cases
Diagnosis
Urethral prolapse is typically diagnosed through a clinical examination. The characteristic ring-shaped, soft tissue protrusion around the urethral opening is usually sufficient to make the diagnosis. Additional tests may be performed to rule out other conditions or complications:
- Urinalysis: To exclude urinary tract infection
- Pelvic ultrasound: To assess the urinary tract if complications are suspected
- In rare cases: cystoscopy (bladder examination) for a more detailed evaluation
Treatment
Conservative Treatment
Mild cases, especially in children, can often be managed conservatively:
- Topical estrogen cream: Applied locally over several weeks to strengthen the periurethral tissue and reduce the prolapse.
- Sitz baths: Warm sitz baths can help reduce swelling and alleviate discomfort.
- Treating underlying causes: Managing constipation or chronic cough to reduce intra-abdominal pressure.
Surgical Treatment
If the prolapse is significant, symptoms persist, or conservative therapy fails, a minor surgical procedure may be required:
- Surgical resection: The prolapsed tissue is excised under general or local anesthesia, and the urethra is sutured back into its correct position. This procedure is generally straightforward with an excellent prognosis.
Prognosis
The prognosis for urethral prolapse is very good. Most patients recover fully after appropriate treatment, whether conservative or surgical. Recurrence is uncommon but may occur in the presence of persistent risk factors such as ongoing estrogen deficiency or chronic increased abdominal pressure.
References
- Lowe, F. C. et al. (2000): Urethral Prolapse in Female Patients. In: Urology 55(6), pp. 890-893.
- Fernandes, E. T. et al. (1993): Urethral Prolapse in Children. In: Urology 41(3), pp. 240-242.
- American Urological Association (AUA): Clinical Guidelines on Urethral Disorders. www.auanet.org
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